Thursday, July 26, 2012

The Morning Drill: July 26, 2012

Several alternative dental workforce models have been proposed as a way to extend care to underserved patients, but a series of reports issued by the ADA July 25 question whether these models can sustain themselves economically.

The reports detail economic modeling of the Dental Health Aide Therapists who provide care in Alaska Native territories; dental therapists currently working in Minnesota; and the proposed but as yet unrealized Advanced Dental Hygiene Practitioner. The studies examine practice parameters in five states where adopting one or more of these models has been under discussion in the legislature or the public health community—Connecticut, Kansas, Maine, New Hampshire and Washington.

Performed by ECG Management Consultants, an agency with extensive experience in research and policy issues, the studies modeled 45 different scenarios based on a comparison between estimated revenues and estimated expenses for each of the three providers under three payer mixes. ECG produced separate reports for the five states and a five-state summary report.

"These studies represent a new way of examining whether alternative workforce models are an economically viable way to improve access to dental care for underserved populations," said ADA President William R. Calnon.

"The studies are a first step, and not the last word. But certainly, lawmakers and public health authorities should consider the factors examined in the studies carefully before rushing to create dental providers that may be unable to fulfill their intended purpose of reducing oral health disparities," he said.

Coke and Pepsi are chasing after the sweet spot: a soda with no calories, no artificial sweeteners and no funny aftertaste.

The world's top soft drink companies hope that's the elusive trifecta that will silence health concerns about soda and reverse the decline in consumption of carbonated drinks. But such a formula could be years away.

That's because the ingredient that makes soda taste good is also what packs on the pounds: high-fructose corn syrup. Artificial sweeteners like aspartame that are used in diet drinks don't have any calories but are seen as processed and fake. Natural sweeteners that come from plants present the most promising alternative, but companies haven't yet figured out how to mask their metallic aftertaste.

Despite the complexities, soft drink makers push on in their search.

"I can't say when it will be here, but it's in the reasonable future," said Al Carey, who heads the beverage unit for the Americas at PepsiCo Inc., the world's No. 2 soda maker.

Hospitals in at least eight states want to know how many hundreds or thousands of their patients have come in contact with a lab technician accused of spreading hepatitis C.

The man, David Kwiatkowski, has the disease, which can pass through contact with contaminated blood, most often via shared needles. Authorities say the Michigan native injected himself with painkillers meant for patients when he worked at Exeter Hospital in New Hampshire and left the syringes for reuse.

He was arrested this month in connection with spreading the disease at Exeter and has been charged with obtaining controlled substances by fraud and tampering with a consumer product, according to an affidavit filed in federal court. He is suspected of stealing fentanyl, a powerful analgesic that is substantially more potent than morphine, the affidavit said.

Thirty Exeter patients have been diagnosed with the same strain of hepatitis C that Kwiatkowski has. Now, officials want to be sure that outbreak has not spread past New England.

Kwiatkowski, 33, worked as a traveling medical technician on a contract basis for hospitals in Arizona, Georgia, Kansas, Maryland, Michigan and New York in the past five years, hospitals and health officials in those states confirmed. U.S. Attorney John P. Kacavas in New Hampshire said he also worked in Pennsylvania.

Asked Wednesday whether anyone in the health care industry ever reported anything about Kwiatkowski, he said: "Many health care practitioners view drug diversion as a problem that requires treatment only. It does require treatment, but it's also incumbent on someone to report it to law enforcement authorities. This may be a big teaching moment for the industry."

Olympic officials are mounting their biggest-ever antidoping program here, aiming to test about half the participating athletes with the help of a corporate-funded lab, new testing tricks and shoe-leather investigative tactics.

About 1,000 people are involved in the effort, including 590 chaperones who will meet medalists just after the event and shepherd them into testing centers. Results will be stored for eight years and available for revisiting as new testing methods are devised.

This massive effort is centered on a state-of-the-art lab built and equipped with £20 million ($31 million) in investment from GlaxoSmithKline PLC, the big pharmaceutical company and Olympic sponsor. Employees from across GSK have helped figure out how to keep the lab (which is the size of seven tennis courts) running 24 hours a day during the Games. It will process about 5,000 samples, starting with the top five finishers in each event plus two competitors selected at random. Tests will be conducted by antidoping agencies and experts from King's College London.

A task force composed of the IOC, the London Olympic organizing committee and the United Kingdom Anti-Doping Agency, or UKAD, will be deploying some new investigative tactics at these Games.